Perinatal depression is a major mood disorder occurring during pregnancy or within the first 12 months post-birth. While the Diagnostic and Statistical Manual of Mental Disorders, 5th edition1 indicates that the presentation must have its onset during pregnancy or within the first four weeks post-birth, clinicians and researchers alike generally accept that symptoms can occur throughout the first twelve months post-birth.2
Although perinatal depression specifically occurs within this defined perinatal period, the symptoms required to meet criteria are the same as that for major depressive disorder.
The key features required to meet diagnostic criteria for a major depressive disorder1 include a combination of symptoms for at least two weeks. These can be categorized as:
- Affective or mood symptoms, such as depressed mood and/or loss of interest or pleasure (key features) and feelings of worthlessness or guilt
- Behavioural symptoms, such as social withdrawal, agitation, or motor retardation
- Cognitive symptoms, such as difficulty concentrating or making decisions
- Somatic symptoms, such as insomnia or hypersomnia, fatigue, and appetite changes.
As some of the physical changes associated with motherhood overlap with the symptoms of depression (e.g. changes in sleeping, appetite and weight), some criteria may confound the identification of depression in this period;1, 3 careful assessment is therefore needed to differentiate these overlapping symptoms and expected life changes.
Psychological assistance may be required when the symptoms of depression are having a notable impact on the woman, her infant and/or her family. This may be experienced in a number of ways, including increased social isolation, increased interpersonal and marital problems, problems bonding with the infant, difficulties providing sensitive and responsive care to her infant, as well as generally struggling with daily activities and demands. At times, suicidal ideation comes to the forefront and a risk management strategy needs to be immediately implemented.
Assessment of perinatal depression generally involves assessing for the presence of depressive symptoms and other possible co-occurring symptoms such as those of anxiety. Assessment is usually conducted via a structured clinical interview which may be complemented by the use of psychometric measures. The impact that the symptoms are having on the woman and on her relationships, including her relationship with her baby, is also assessed together with an evaluation of psychosocial factors such as history of depression or other mental health disorders, and social support.2
Treatment of perinatal depression varies depending on severity and psychosocial factors present, but generally includes2:
- Provision of psycho-education around perinatal depression, lifestyle advice and pre- and postnatal care
- Addressing general issues through non-directive counselling, including encouraging psychosocial supports and addressing any partner relationship issues
- Provision of evidence-based psychological therapies to address depression and anxiety, such as cognitive behavioural therapy and interpersonal psychotherapy which have the strongest evidence supporting their effectiveness
- Specialist assessment or intervention for complex or co-morbid presentations. In these cases, indicators for referring on need to be considered, as specialist involvement may be required to tackle specific issues such as substance abuse, or domestic violence
- Assessment of, and possible psychotherapy for, the mother-infant relationship.
Pharmacological treatment might also be involved, though the use of anti-depressant medication raises particular issues for women in the perinatal period (e.g., concerns about breastfeeding).4 It is important for women to understand the potential risks and benefits of pharmacological treatment and for psychologists to work closely with the prescribing physician.